This thesis investigates ‘the doing’ of the Swedish social insurance program Activity Compensation (AC). AC is an example of disability policies in Western welfare states. These policies have two goals: to ensure financial security and to promote social participation. In 2003 AC replaced Early Retirement Pension for persons aged 19 to 29 years and who, for medical reasons, have reduced work capacity. Three features characterize AC. Young adults are differentiated in a separate system. For them, benefits are time-limited. Benefits include an established right to participate in activities. Doing AC is studied bottom-up. Interviews with two actor groups have provided the empirical base: 1) persons accorded AC and medically certified to have an anxiety and/or a depression diagnosis and 2) the respective administrator(s) at the Swedish Social Insurance Agency. National legislative preparatory texts and legal documents complete the data. The conclusions of this study are three-fold addressing goal displacement and non-contact. Firstly, a discursive change in respect to the denotation of social participation within the politics of principle has appeared throughout OECD countries over the last decennium. This goal displacement obscures the goal of economic security emphasizing the profitability of work. AC explicitly manifests this change in establishing a right to activity participation for beneficiaries. This displacement is without full impact in the politics of practice when actors’ experience of doing AC is examined. Financial security remains the foremost goal in the local politics of practice mirroring the initial function of safeguard for those with reduced work capacity due to certified illness. Relating to this lexical displacement, the study concludes that social participation is revealed as a goal to be realized in a specific form, salaried employment, within a distinct arena, the labor market. Values such as life-quality are neglected as regulatory efforts to get persons on the track to work have been underscored. Finally, the prescribed contact between the insured young adults and their administrator(s) is not consistently present. This contact is a necessary condition for the intended planning of activities to take place. When non-contact prevails, the established regulatory right to participate in activities can not materialize.

Background. In Sweden 10 percent (550,000) of the labour force, aged 18 to 65 years are disability pensioners and about four percent are on sick leave. The knowledge of the course from healthy individual to disability pensioner is not well known and was the theme of this thesis. Objectives, Material and Methods. The aims of the thesis were to follow the study population regarding sickness absence, health care utilisation, quality of life, and survival. Population based data including 14,538 women and men from three cities in Sweden were used, of whom 1,952 were granted a disability pension at baseline or received one during follow up. Register data, including sickness spells, health care utilisation, and mortality data during 30 years of follow up, and questionnaire data including socio-economic and quality of life data were used. Results. The most powerful determinant for being granted a disability pension was cumulative annual sick leave days, more powerful than all other tested determinants together. The degree of explanation for all determinants combined was 96%. Health care utilisation among disability pensioners continued to be high also after disability pension, 2.3 times higher for hospital admissions and 8 times higher for primary health case appointments than among referents. Disability pensioners had lower quality of life than non-pensioners and old age pensioners. For those who became disability pensioners after the baseline measurements quality of life measures decreased progressively until disability pension was granted and were then stabilised on a low level. During follow up 525 (7.6%) subjects died. Compared with subjects who did not become disability pensioners the hazards ratio was 2.78 among women and 3.43 among men, even when the effect of a number of other outcome affecting variables were taken into account. The mortality differences were not explained by underlying disease. Conclusions. The risk of disability pension may be predicted but only late in the course of events. Disability pensioners continue to have a high level of health care utilisation, and have a worse quality of life development and a higher mortality rate than non-pensioners. Given the unfavourable outcome of disability pension, other means of managing the reduced work capacity might be considered.

This study explores the experiences of the Swedish front-line social workers (socialsekreterare) in the municipal income support unit, Young Adults, monthly assessing the income support applications as well as daily processing the activation programs for young adult clients with mental ill-health combined with social-medicinal vulnerabilities, also referred to as young adults with complex needs. Furthermore, this study aims to illuminate the ever changing conditions of the Swedish welfare state and its underlying driving forces through the lens of the social workers. 9 Semi-structured distance interviews with 11 social workers from 6 municipalities belonging to 5 regions in Sweden, were conducted for the collection of qualitative data. It has been analyzed by the inductive-deductive coding as well as a theoretical frame consisting of concepts such as discretiona and advocacy of M. Lipsky, and reciprocal interaction (Wechselwirkung), form and contents, and call of G.Simmel. The result and analysis show that the rehabilitative approach based on the interactions and relations with the clients, is prevalent through the social workers’ processing of the activation program. It seems to be effective in a dyad, between the social workers and the client while the social workers’ discretion is maximized for the utilization of the agency (unit) activation resources. However, it proved not to be as effective in a triad or more when an extern agent outside of the unit, Young Adults begins to be involved. The tension is a fact and the social workers’ discretion is minimized when they have to process the activation program for the clients who are neither “active enough” to have a job in the ordinary labor market, nor “sick enough” to be eligible for the stately activity compensation (aktivitetsersättning) from the Social Insurance Agency (Försäkringskassan) which heavily relies on the medicinal expertise for its decision making. The social workers’ experience to fail to deliver the best possible results out of the activation programs, and the client relationship built on the rehabilitative approach turns out to be unsustainable, which can indicate the discrepancy between the rehabilitative approach as well as the activation programs, as content, and the unit, Young Adults, as form. Even though the social workers daily carry the ideological as well as the social-political tensions between the medicalization and the activation through the ever changing reality of the Swedish welfare state, their mandate to make an impact on the decision making of the activity compensation program, is rather limited, reflecting the Swedish welfare state’s expectation for the professionalism of the social workers. Rather striking that the social workers, however, confess that they in spite of the pressure of organizational efficiency as well as socio-economic discourse of digitalization undermining the concept of the unit, Young Adults, are not willing to give up the rehabilitative approach for the client’s sake but also to protect their unit, Young Adults, which postulate that they are not the gatekeepers in the agency but the advocate for the clients. In this moment, they also seem to know, and even have the call, the essential, if not mandatory, element needed to be landed in the perfect society of G. Simmel.